Evidence Based Practice

Question 1

What is the best available evidence?

Answer 1

Rigorously conducted research

Question 2

What can evidence show?

Answer 2

The effectiveness and the cost effectiveness of things in healthcare

Question 3

What wastes resources?

Answer 3

Ineffective and inappropriate interventions

Question 4

Why do we use evidence based medicine?

Answer 4

Without evidence we could do harm

Question 5

Inequities in treatment is produced by…

Answer 5

Variation in treatment

Question 6

What did Cochrane do?

Answer 6

Criticised medics for not using evidence.

Called for a register of Randomised Control Trials.

Question 7

When several studies have been done what is needed to identify a true trend and change practice accordingly?

Answer 7

Meta-analysis and systemic review.

Question 8

What does a systemic review attempt to eliminate?

Answer 8

Bias

Question 9

Why are systems reviews useful?

Answer 9

Helps address clinical uncertainty

Highlights gaps in research and the poor quality studies

Question 10

Why do medics use systemic reviews?

Answer 10

Up to date evidence
Time saving - the clinician doesn’t have to collate and analyse themselves.
Research developments to implantation time shortened.
Quality control
Doubt reduced.

Question 11

What can systemic reviews be used to make to help clinical decision making?

Answer 11

Guidelines

Question 12

What is a critical appraisal tool?

Answer 12

A tool that someone can use to decide on the validity of the systemic reviews.

Question 13

What are the two critiques of evidence based medicine?

Answer 13

Practical criticisms

Philosophical criticisms

Question 14

What challenges face evidence based practice?

Answer 14

Impossible task to keep a cross specialty review.
Expensive to find evidence and change practice.
Not always feasible, necessary or desirable.
Biomedical it come not always valid for a guideline for clinicians.
Faith in the research provider is needed.

Question 15

What’s the difference between practical and philosophical criticism of evidence based medicine?

Answer 15

Practical is the questioning of possibility

Philosophical is the questioning of desirability

Question 16

Why practically might evidence based medicine not be done?

Answer 16

Impossible 
Challenging and expensive 
Not feasible, necessary or desirable 
Outcomes biomedical and not link able to clinical guidelines 
Requires good faith in research

Question 17

What philosophical criticisms are there of evidence based medicine?

Answer 17

Doctors mode of reasoning doesn’t match
Population to individual comparison not appropriate
Doctors to become unreflective rule followers
Legitimising rationing
Professional autonomy and thus responsibility inhibited.

Question 18

What are the barriers to getting evidence into practice?

Answer 18

Doctors unaware of evidence
Habit and organisations meaning evidence isn’t implemented
Commissioning mismatch
Lack of resources